How Hard Is the ABIM Certification Exam? ABIM Exam Explained.

• The ABIM exam format is composed of 240 multiple-choice single-answer questions.
• You’ll be tested on these questions in four sessions of two hours each.
• On exam day, be prepared to spend up to eight hours in front of a computer, and another two in breaks and orientation instructions - ten hours total.

Note: if you are going to be taking the ABIM certification exam, you've just spent close to ten years learning one of the most complex subjects on earth, and passed every standardized test thrown at you to get this far. You’ve got this!

Scoring is based on a standardized scale of 200 to 800, and anything at or over 366 is a passing score.

The failure rate on the ABIM certification exam hovers around 1 in 10.

Around 9,000 people take the exam each year:

• 2017: 90% pass rate
• 2018: 91% pass rate
• 2019: 91% pass rate
• 2020: 93% pass rate
• 2021: 88% pass rate

Within three months of last exam date in the area, you’ll get your notification of your results, and an examination score report. It’s all pass/fail.

Here's a sample score report from ABIM.  You'll get an overall score and a performance by section breakdown.

The question structure is designed as case-based multiple-choice, single-answer questions - we call these “boards style” questions. Boards style questions are designed strictly as assessment tools - if presented with a brief summary and adequate diagnostic information, can you identify the distractors and select the appropriate answer?

The distractors will usually be common diagnostic errors or will be designed to look like the right guess, if you aren’t completely familiar with the topic. There are a few questions that will be memorization-based rather than case-based, but most of the test is case presentation and diagnostic test interpretation.

ABIM Exam Questions and Answering Tips

You’ve already been through several of these high-stakes exams to get to this point, you’re completely familiar with the structure, and tips for dealing with assessment questions, but it never hurts to recap:

• Read the question stem twice. The ABIM questions aren’t going to be ‘tricky’, but you can get some odd wording on the stem.
• Watch for words like always or not that can change the answer being asked for.
• If the answer is glaringly obvious, still check the distractor answers.
• If the answer is not glaringly obvious, eliminate each answer one by one.
• Math says you’ve got two minutes per question, but you know it doesn’t work that way, because you’ve been taking these half your life. Half will take less than 30 seconds. There’s plenty of time. If the question looks ugly, come back to it.
• Never leave a question blank - a ‘no answer’ is incorrect, take your best guess.
• If you’re stuck, ignore the selections and try to answer the question stem without looking at the answers. Something about the distractors may be throwing you off.
• You’re going to have some sound questions - S1-S4 primarily - the audio is short, but you won’t be rushing through those.
  

The exam blueprint doesn’t vary by much, year-to-year, but the questions related to the topics do vary.  They keep a constant churn of new question development and retirement of questions to keep the exam fresh, and as relevant as a standardized MCSA (multiple-choice, single-answer) questions covering years of learning can be.

The general ABIM Internal Medicine exam blueprint is designed to cover medical content categories and cross-content categories.

Pay careful attention to cardiovascular disease in your studies. Cardiology and pulmonary examination are almost a quarter of your exam. You're going to have questions with audio clips, primarily in cardiology - but auscultation is part of the examination format.

Know your heart and lung sounds - rhythms, murmurs, wheezes, etc.

You’re going to have ECG questions.

Stick to core diagnostics and treatment - don't sweat the oddballs.

The ABIM introduces new questions on the exam each year, to help identify and select new questions for future exams. You won’t know whether you have a non-scored question or a real scored question when you are looking at it.

The rate of new non-scored question introduction is generally 14% of the exam. If a question seems off-the-wall, you may be a living experiment, or you may have just hit the common questions in some of the smaller topic categories. Diagnoses on common diseases and conditions are pretty stable.

Have a study plan and pace yourself.

Studying for the ABIM exam is not a sprint - it's a marathon.  It takes a plan to score high - and stay sane!  Need a ABIM exam study plan?  We've put together a detailed plan for preparing for the ABIM certification exam in our free Internal Medicine Boards Survival Guide.  

A mix of question types increases retention and learning.

There’s a tendency to want to study for the exam using just boards-style questions. These are assessment questions, designed to show what you know well, what you “sort of” know, and what you don’t know at all. They are a useful predictor for how you are going to do on the exam.

We also use in Med-Challenger Internal Medicine, a lot of complex questions. These are teaching questions, designed to force you to stop and think about a topic. Complex questions generally have a multiple-select component, or a very long stem. And, you’ll usually see a very long, content-rich answer explanation on the question, whether you get it right or wrong. We use these to present confounding factors in diagnostics.

When you hit a question and get it wrong, it sticks with you. You’ll remember that topic for a lot longer, and that’s the purpose of dropping a lot of complex questions into a study or teaching product. Nothing is going to make it fun, but know that they are in there for a reason. We also have all the standard boards-style questions (and you can make custom exams for assessment using just boards-style questions).

A mix of boards-style and complex questions do a lot better at driving long-term retention than just flipping through a few hundred assessment questions. 

You’ve already encountered summary books, guides and PDFs for ITE preparation. ITE exams, little mini-boards, are probably the best indicator of how you’ll do on the ABIM certification exam. Review the brief ITE prep pearls and ITE exams.

There are a lot of recorded board review lectures at different prices (or you can go to a live course, for that matter). These aren’t useless, but sitting through lectures is one of the poorest learning formats. The rank for memory retention goes from reading, lectures, interactive questions, simulation, hands-on in order of information retention. You’ve sat through a zillion lectures, read dozens and dozens of textbooks - you don’t need to recap years worth of learning, you want to be confident you don’t have knowledge gaps.

That’s where question banks organized around the ABIM topical blueprint come in handy.  With features like prescriptive learning (identify strengths or weaknesses by topic), custom exam formats (like constructing a topic mini-boards exam), well-designed and curated question banks can identify problems and remediate them in less time.

Thousands of internal medicine physicians have used Med-Challenger's Internal Medicine Exam Review to prepare for their ABIM exams - and the results and feedback have been extraordinary.